Palliative and Supportive care

EGFRI-Related Skin Toxicity

Information, treatment algorithms and educational materials for healthcare professionals and patients about skin problems that may occur when being treated with anti-EGFR drugs

Multikinase Inhibitor Related Skin Toxicity

Information, treatment algorithms and educational materials for healthcare professionals and patients relating to the management of dermatological toxicities in patients treated with multikinase inhibitors.

Drug-Drug Interactions with Kinase Inhibitors

Information and education online resource for healthcare professionals on drug-drug interactions which can arise from the use of kinase inhibitors

Abstract

Background

Anemia is frequently associated with acute lymphoblastic leukemia (ALL) both at presentation and during the course of treatment. Till now Indian and international data is lacking regarding the prevalence and type of anemia in ALL patients on maintenance therapy who receive prolong courses of antifolate drugs for almost 2 years as per various protocols. In this study we evaluated the clinical profile of anemia in ALL patients on maintenance therapy.

Methods

Both adult and pediatric patients with ALL on maintenance therapy were included. Patients who were on other treatment phases were excluded. Patients with anemia of grade 2 or more i.e. hemoglobin (Hb) ≤ 10gm/dl were evaluated for the type of anemia and serum iron, ferritin, folate and vitamin B12 levels were done as clinically indicated according to the type of anemia.

Results

During the study period (from March 2015 to July 2016) 98 ALL patients were on maintenance phase of treatment. Median age at diagnosis was 9 years (range, 1-55). Amongst these patients, 72.5% (n = 71) were B ALL [3 patients (4.1%) were Ph positive], 27.5% (n = 27) were T ALL. 62 patients (63.5%) were high risk and 36 patients (37%) were standard risk (NCI criteria). Fifty patients (69%) had normocytic normochromic anemia, 21% (n = 15) had macrocytic anemia, and 10% (n = 7) had microcytic hypochromic anemia. Out of 72 patients with grade 2 or more anemia, 40 patients had documented micronutrient deficiency (iron, folate or vitB12) and amongst them all (n = 40,100%) patients had folic acid deficiency, 17.5% (n = 7) had iron deficiency, 17.5% (n = 7) had vitamin B12 deficiency and 25% (n = 10) were having more than one micronutrient deficiencies.

Conclusions

Anemia is a common clinical finding in ALL on maintenance therapy; evaluation of anemia for subtype and identification of specific micronutrient deficiency can guide the corrective therapy. As a second part of our ongoing study, we are supplementing the respective micronutrient deficiency and following these patients for treatment outcome.